We reviewed a lady in a care home. She was, "causing a disturbance."
She was holding hands with other ladies, talking suggestively, then at times cuddling, stroking and kissing them. She and the other ladies all have advanced dementia.
The care home sought advice on how to manage this.
Knowing my foibles, they'd already looked for delirium, considered diet and fluids and constipation, arranged for a district nurse to do bloods to exclude infection and common physical causes for acute on chronic confusion and sussed out and documented what the circumstances of this behaviour were.
A life long heterosexual woman, with an active libido throughout her life, she sought companionship and intimacy with accessible men.
Her dementia cued her in to selecting men through one principle determinant, which of a fashion makes sense. She'd progress amorous overtures to anyone in trousers.
I don't have a pill to stop that one.
This is fascinating, because I find that I'm not sure how I should respond to the situation. My personal opinion is to cheer your amorous lady on, as I've no reservations about same-sex relationships in principle. Professionally, however, I'd have to make myself take stock of the whole situation...
What have you suggested?
And not the post I was hoping for.
It reminds me of this story in the BMJ.
Oh how very fascinating, as M&2S has said. I must say Shrink, you're making me more and more interested in old age psychiatry! (Dementia and delirium were one of the few things in psych last year that I truly found fascinating to learn 'bout!)
Oh I am so glad that there are no pills for this one!
M&2S the point was that she wanted a male/female relationship but didn't realise many of the folk she was kissing and cuddling were female. In her mind, if they wore trousers, they were male.
What did we do? We ammended her careplan so it was ensuring she didn't generate risk to others in the carehome (Safeguarding Adults limits choices/directs content of care), increased staff input and direction who've consequently facilitated same sex company that her family feel would be what she'd still wish for. Ticks the boxes for satisfying safety, legislation, dignity and past wishes which is about as good as I can hope for.
Dr Grumble, I've never been so bold as to orchestrate quite such an avant-garde Care Plan! It is a paper we've considered when it came out, and we've sanctioned relationships with prostitutes for folk with mental disorder (but not arranged it for them). In this case it's a touch different since she's an incapacitated adult (within the meaning of the Mental Capacity Act 2005) and determining who has sex with her, which she can't validly consent to, is outwith our gift in Best Interest meetings.
Xavier, I must confess, to my shame, that I always fuond dementia/delirium tediously dull and was never drawn to mental health services for older people through that. But, over time, it's hooked me :-)
Milo, indeed, sometimes it's good to live in the really real world and not clutter things with medicalising stuff or medicine.
I just came upon your blog. I am a physician but also have severe mental illness (no longer practicing). I don't know much about care homes or geriatric psychiatry. I do know, however, that affectionate touch is healing for people, even (or especially) when its goal is not primarily sexual gratification.
Could this woman be craving hugs and caresses, without necessarily being driven by an urge to engage in sex? Maybe just human touch would be good for her, and others in her situation. I hope that if dementia strikes me in future years someone will set me up with occasional human contact, perhaps in the form of professional massage.
Even in the present day, there have been times when my psychiatric symptoms felt overwhelming, and therapeutic massage brought me back to a place of peace. (I realize, of course, how fortunate I was to be able to afford such services.)
Obviously, keeping things safe and appropriate is the first priority in your care setting. And society has neither financial resources nor widespread will to do something like provide (e.g.) chair massages to residents in facilities. But in a perfect world, we would recognize how much better we feel when someone comforts us by touching our bodies. I doubt this effect diminishes with advanced age or dementia.
Ah - it all makes more sense now! Her care plan sounds lovely and dignified.
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